Blood pressure vs altitude in hypertensive and non-hypertensive himalayan trekkers

Introduction: Determine blood pressure (BP) response to changes in altitude in Himalayan trekkers with and without hypertension (HTN). Methods: BP was measured in Lukla (2800m), Namche (3400m), and either Pheriche or Dingboche (4400m) on ascent and descent. Hypertensive subjects were defined by self-reported diagnosis of HTN. Results: Trekkers had HTN (H, n=60) or no HTN (NH, n=604). Of those with HTN, 50 (83%) took one or more BP medications including ACEIs/ARBs (n=35, 48%), Ca++ channel blockers (n=15, 22%), beta-blockers (n=9, 13%), thiazide diuretics (n=7, 10%), and others (n=5, 7%). At 2800m, systolic BP (SBP) and diastolic BP (DBP) were greater in the H group than in the NH group [mean SBP= 151mmHg (95% CI 145.4-155.7) vs 127mmHg (95% CI 125.5 128.0); mean DBP=88mmHg (95% CI 85.1-91.7) vs 80mmHg (95% CI 79.3-80.8)] and remained higher at both 3400m [mean SBP=150mmHg (95% CI 143.7-156.9) vs 127mmHg (95% CI 125.8-128.5); mean DBP=88mmHg (95% CI 84.3-90.8) vs 82mmHg (95% CI 80.7-82.5)] and 4400m [mean SBP=144mmHg (95% CI 136.7-151.7) vs 128mmHg (95% CI 126.4-129.5); mean DBP=87mmHg (95% CI 83.2-91.7) vs 82mmHg (95% CI 81.3-83.2)]. Between 2800m and 3400m, BP increased in 37% of trekkers, decreased in 25%, and did not change in 38%; from 3400m to 4400m, BP increased in 35% of trekkers, decreased in 26%, and did not change in 40%. Prevalence of severe hypertension (BP\u3e180/120mmHg) was similar across altitudes but higher in the H group (9%; 10%; 8% vs 0.7%; 0.6%, 0.3%) at 2800m, 3400m, and 4400m, respectively. No subjects reported symptoms of hypertensive emergency (chest pain, stroke, etc.). Conclusion: Blood pressure response to altitude is variable. High prevalence of severe hypertension in hypertensive trekkers warrants further study regarding BP control at high altitude

Psychotherapeutic practice in paediatric oncology: four examples

Psychotherapy, often used with children treated for a solid tumour, is seldom described. We present four examples of such therapies: a mother who refused enucleation for her 7-month-old boy; a boy's jealousy towards his sister who was being treated for a brain tumour; a teenager troubled by his scar; a 7-year-old boy embarrassed by the unconscious memory of his treatment when he was 5 months old. All names have been changed, for reasons of privacy. Psychotherapies aim to help children and parents to cope with the violent experience of having cancer, to recover their freedom of thought and decision-making concerning their life, their place in the family, their body image, their self-esteem, their identity. These descriptions of brief psychotherapy could help paediatricians to gain a more thorough understanding of the child's experience, to improve collaboration with psychotherapists and to confront clinical skills of psychotherapists. © 2000 Cancer Research Campaig

Treatment of gastroparesis: a multidisciplinary clinical review

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75594/1/j.1365-2982.2006.00760.x.pd